Botriomycoma, also called pyogenic granuloma or lobular capillary hemangioma, is a small inflammatory vascular tumor that bleeds easily on contact. It is benign. The need to take care of it is mainly due to the embarrassment it represents.

Botriomycoma looks like a small, red, soft, fleshy bud. It is separated from the healthy skin by a peripheral groove at its base, which is quite characteristic.

This unsightly growth is a small inflammatory vascular tumor. It can appear spontaneously on the skin or on a mucous membrane, but occurs more often in areas that have suffered a microtrauma: 

• ingrown nail ;
• small wound;
• insect or needle bite that becomes infected;
• panaris, etc. 

This is why it is commonly found on the fingers and toes, but also on the face, lips, gums or the genital area. 

Botriomycoma gradually grows, over one to three weeks, to reach 0,5 to 2 cm in diameter. Seeing it appear is not very reassuring, but there is no need to worry too much: the lesion is benign. It is painless and harmless, but can be discomfort. It can, for example, be sensitive to the touch or rub against the shoe. In addition, very vascular, it bleeds easily at the slightest contact.

Botriomycoma can occur at any age, although it is more common in children under 5 years old. In adults, it often follows a small trauma or surgery. It can also occur during pregnancy, in particular on the gums, or after certain systemic treatments (having an action on the whole body). It is particularly favored by anti-acne drugs based on isotretinoin or by antiretrovirals of the protease inhibitor type.

This outgrowth, isolated, seems to result from an inflammatory reaction: it is infiltrated by cells of the innate immune system, in particular by polynuclear neutrophils. But the exact cause of this proliferation of blood capillaries remains unknown today. An infectious origin has been mentioned but never proven.

The only symptom of this pathology is this small, red, soft pimple that appears on the skin. It is sometimes epidermized, sometimes eroded. In the latter case, it tends to bleed easily, and therefore to be crusty and black.

The diagnosis of botriomycoma is clinical. A biopsy with histological analysis is not necessarily necessary, except in adults, when the doctor needs to rule out with certainty the hypothesis of an achromic melanoma, that is to say of an unpigmented melanoma .

Without treatment, botriomycoma can regress spontaneously, but over a very long time. However, some consider it unsightly. Above all, repeated bleeding from this growth can be annoying on a daily basis.

This is why a small surgery is often better than waiting. There are several options for this:

• cryotherapy, a dermatological technique consisting in applying very cold liquid nitrogen to the lesion to destroy it, as is sometimes done against a wart;
• electrocoagulation, that is, the application of a needle through which an electric current passes over the tumor, to kill the cells and cauterize the vessels;
• surgical excision, which involves removing the growth with a scalpel and then closing the skin.

The last two methods seem to be the most used, as they are the ones that give the best results. The advantage of the latter method is that it allows for laboratory analysis. But the important thing is above all to remove as much as possible to avoid recurrence.